Non-Hodgkin's lymphoma of the urethra: a rare extranodal entity

Urethral large B-cell urethral lymphoma: A case report and literature review

OBJECTIVE

We report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer.

CASE REPORT

A 68-year-old woman presented with a non-healing urethral ulcer accompanied with vulvar pruritus, which failed to medical treatment. Her medical history was unremarkable, lacking fever, weight loss or unexplained fatigue. There were no enlarged lymph nodes or palpable liver or spleen upon physical examination. Pelvic examination revealed an ulcerative lesion arising from the posterior wall of the urethral meatus. Cystourethroscopy showed no bladder involvement. Surgical excision of the urethral ulcer was done and immunohistochemical report showed a diffuse large B-cell lymphoma. Bone marrow needle biopsy and computed tomography were done and the diagnosis of primary diffuse large B-cell urethral lymphoma stage IEA was made. She underwent six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab and was free of disease for 51 months.

CONCLUSION

This report of urethral lymphoma was presented as a non-healing ulcer initially, which was totally different previous reports, presenting with bleeding, either vaginal or urinary, urinary frequency, dysuria, urine retention and self-perceived mass, suggesting that unhealed ulcer on the perineal area should be promptly evaluated and avoidance of unnecessary delayed therapy for possible curable disease.

Diffuse large B-cell lymphoma transformed from mucosa-associated lymphoid tissue lymphoma arising in a female urethra treated with rituximab for the first time

A 30-year-old female patient presented to the gynecology clinic with a small (painless) swelling at the urethral orifice. She underwent surgical excision of the lesion. Pathological examination revealed non-Hodgkin's lymphoma of diffuse large B-cell type and mucosa-associated lymphoid tissue type, stage IE. The patient refused radiotherapy. Accordingly, we started CHOP-R chemotherapy. She received a total of 6 cycles of CHOP and 8 cycles of rituximab. Patient follow-up was done 3 months later through CT scan and cytoscopy confirming the complete remission. The patient has been disease-free for 4 years. We reviewed 26 cases of this rare entity reported previously.

A case of intraepithelial squamous cell carcinoma arising from urethral caruncle

A 62-year-old female patient had occasional bleeding from a mass in the urethral meatus. She had been conservatively treated with steroid ointment at another hospital for 1 year, but the bleeding had persisted. The patient was therefore referred for further treatment. A reddish mass, measuring 5 mm in diameter was noted at the posterior lip of the urethral meatus. The mass was diagnosed to be a urethral caruncle and was removed. Microscopically, the squamous epithelium, which covered the urethral caruncle, was found to be keratinized, with the proliferation of atypical cells with swollen nuclei in the entire mucosal layer. The mass was finally diagnosed to be intraepithelial squamous cell carcinoma arising from the urethral caruncle.The occurrence of intraepithelial squamous cell carcinoma arising from a urethral caruncle is extremely rare. A search of the English literature revealed only 1 other case report.

MR findings of prostatic urethral polyp in an adult

We report MR imaging characteristics of a prostatic urethral polyp in a 35-year-old man. Traditionally, the methods of diagnosis include computed tomography, transrectal sonography, voiding cysto-urethrography, intravenous pyelography, urethroscopy, and cystoscopy. To our knowledge, MR findings have not been previously described. In this case, MR imaging clearly demonstrated a polypoid tumor located in the prostatic urethra with a stalk connected to the bladder neck. A pathological study revealed the polyp consisted of a fibrovascular core covered with a double layered, prostatic-type epithelium.

Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising from the male urethra. A case report and review of the literature

Primary non-Hodgkin's lymphomas rarely arise from the lower urinary tract, the urethra being the most uncommon site of origin. Herein, we report the immunohistochemical findings of a case of primary marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) arising from the male urethra. To clarify the clinicopathological findings of primary urethral lymphoma, we reviewed 14 previously reported cases. A 56-year-old man presented with gross hematuria. Cystourethroscopy demonstrated a nodular bulge of the urethral wall. Histologically, a transurethral biopsy specimen showed a dense lymphoplasmacytoid infiltrate in the urethral mucosa. The tumor cells were composed of centrocyte-like cells, plasma cells and plasmacytoid cells. A few plasma cells contained intracytoplasmic pseudoinclusions (Dutcher bodies). Immunohistochemical study revealed monotypic intracytoplasmic kappa-light chain in the plasma cells and plasmacytoid cells. The patient received a total of 50 Gy extrabeam irradiation. Follow-up 21 months later did not disclose any sign of local or other recurrences.

Conformal radiotherapy in primary non-Hodgkin's lymphoma of the male urethra

Primary malignant lymphoma of the urethra is very rare. Fifteen cases are reported in the literature and only four of them belong to the male urethra. We present the fifth case of primary Non-Hodgkin's lymphoma of the male urethra that is managed by conformal radiotherapy.

Lymphoma at uncommon sites

Lymphoma can often present in unusual situations. This article provides a comprehensive review of the literature in which both non-Hodgkin's lymphoma and Hodgkin's disease are discussed.

Primary lymphoma of the male urethra

An elderly man presented with urinary outflow obstruction and a smooth mass arising from the bulbar urethra. Biopsy revealed large cell lymphoma, B cell subtype. A literature review revealed no previous cases of undisseminated lymphoma arising within the male urethra. The obstructing mass and symptoms resolved with multiagent chemotherapy.

Malignant lymphoma in the female urethra

Primary malignant lymphomas in the female urethra are extremely rare. We report a 63-year-old woman who presented with a localized tumor of the urethral meatus. The tumor was classified as a non-Hodgkin's malignant lymphoma, a diffuse, small cleaved cell type according to the Working Formulation classification. Immunohistochemistry confirmed that the tumor was derived from B cells. The patient underwent chemotherapy and remains free from evidence of the disease 3 yr after excision. To our knowledge she is the seventh case of malignant lymphoma in the female urethra reported in the English literature.

Malignant lymphoma of the urethra: report of a case with detection of Epstein-Barr virus genome in the tumour cells

We report a primary non-Hodgkin's B-cell lymphoma of the urethra in a 78-year-old female. Serum antibodies for Epstein-Barr virus (EBV) were negative, but there was a 40-fold increase in antibodies to EBV-associated nuclear antigen. Using PCR and in situ hybridization techniques, EBV genome was found in the tumour cell nuclei.

Primary lymphoma of female urethra: long-term control by radiation therapy

We report a case of primary urethral lymphoma successfully managed by external beam radiation therapy. Long-term freedom from recurrence in this case suggests irradiation is a viable treatment option for this rare malignancy.

Primary malignant lymphoma of the female urethra: report of a case and review of the literature

Primary extranodal lymphoma of the female urethra is rare. We present case 10 and review the literature. Management in the past has varied markedly. Strategies have included simple excision, external beam and intracavitary radiation therapy, and multiple agent chemotherapy. The majority of patients have done well: 7 of 10 are alive with no evidence of disease. Newly diagnosed patients should undergo complete staging with the Ann Arbor staging system and the tumors should be classified histologically according to the Working Formulation for Clinical Usage. Therapy must be individualized but in most cases we recommend that patients be treated as if they have systemic illness, with multimodality therapy.